Objective: To evaluate the value of modified early warning score ( MEWS ) in predicting mortality of critically ill patients admitted to emergency department.
Methods: A prospective cohort study was conducted. Clinical data of emergency patients admitted to resuscitation room of Peking Union Medical College Hospital from Feburary 13rd, 2014 to April 20th, 2014 were collected, and their MEWS were calculated based on medical records and their clinical outcomes was followed. Incidence of primary outcome ( 3-day mortality ) and secondary outcome [ all deaths and composite outcome of intensive care unit ( ICU ) transfer, cardio-pulmonary resuscitation, and death ] were compared between MEWS positive ( MEWS≥5 ) or negative ( MEWS 0-4 ) patients, and multi-regression logistic analysis was done to look for the impact factors of primary outcome in these patients.
Results: 176 patients, among them 98 ( 55.68% ) were male, were enrolled in the study. Their mean age was ( 56.86±21.46 ) years old. Mean MEWS was 4.30±2.74. There was 74 cases in MEWS positive group, and 102 in negative group. Primary endpoint occurred in 41 patients, and the 3-days mortality in MEWS positive group was significantly higher than that in MEWS negative group [ 37.84 ( 28/74) vs. 12.74% ( 13/102 ), odds ratio ( OR ) = 4.167, 95% confidence interval ( 95%CI ) = 1.973-8.804, P < 0.001 ]. At the meantime, incidence of all death [ 54.05% ( 40/74 ) vs. 17.65% ( 18/102 ), OR = 5.490, 95%CI = 2.770-10.883, P < 0.001 ] and the incidence of ICU transfer, cardio-pulmonary resuscitation and death [ 64.86% ( 48/74 ) vs. 25.49% ( 26/102 ), OR = 5.396, 95%CI = 2.809-10.366, P < 0.001 ] were also significantly higher in MEWS positive group as compared with negative group. Multi-regression logistic showed abnormal mental status ( OR = 3.606, 95%CI = 1.541-8.436, P = 0.003 ) but not MEWS ≥5 ( OR = 1.672, 95%CI = 0.622-4.494, P = 0.308 ) was the predictor of 3-day mortality in emergency admitted critically ill patients.
Conclusions: Although the incidence of severe adverse events is significantly increased in patients with MEWS ≥5 compared with those with MEWS 0-4, MEWS≥5 cannot be an efficient predictor for 3-day mortality. Abnormal mental status shows some predictive value for early mortality in critically ill patients seen in emergency department.